Valvular Insufficiency/Heart Valve Defects

There are numerous causes of heart valve defects and deterioration, including inherited defects, bacterial infections, reaction to drugs, and age-associated aortic valve stenosis (narrowing). Rheumatic heart disease can also cause valvular heart problems. Although rheumatic heart disease has greatly diminished since the advent of antibiotics to treat streptococcal infections, it still affects more than 1 million Americans and causes about 6000 deaths per year. Since heart valve diseases are anatomical in nature, it is challenging to address an existing valve defect from a nutritional or drug standpoint.

The most common serious heart valve defect is called aortic stenosis. Aortic stenosis is normally an age-related disease that consists of the aortic valve progressively narrowing and reducing the amount of blood that is able to be pumped to the body by the ventricle. The result is often ventricular enlargement, as the heart muscle has to grow to allow it to pump harder to force blood through the narrowing aortic valve.

In valvular stenosis, a valve that fails to open properly impairs the forward flow of blood to the body. In either case, the heart has to work harder to pump enough blood to the body, eventually leading to heart muscle damage. Congestive heart failure, syncope (fainting), and arrhythmias are common signs of valve disease.

Diagnosis

Valvular heart disease is most easily diagnosed by Doppler echocardiography. This noninvasive diagnostic technique makes it possible to measure blood flow and to evaluate the extent of valve defects. The color Doppler echocardiography gives the physician a better survey of the severity of valve disease, and the spectral Doppler provides an exact analysis and quantification of the valve defect and the degree of stenosis. The most precise diagnosis is made by cardiac catheterization and angiocardiography carried out in the vascular lab, generally by an invasive cardiologist, allowing immediate intervention to take place.

Cardiac disability and death from congestive heart failure will result if the aortic valve cannot be reopened or replaced. Valve-replacement surgical procedures currently are the only effective long-term therapy. Regrettably, this surgical procedure also has numerous potential long-term side effects, especially in elderly people who often need an aortic-valve replacement. The potential development of nonsurgical therapies to correct aortic- valve stenosis offers some hope of an alternative to valve-replacement surgery.

Treatment

Conventional Treatment
Depending on the type of valvular problem, patients often can go for many years without any special treatment. A common example is a mitral valve prolapse. Up to 7% of the population has mitral valve prolapse, which for unknown reasons are most common in women. In most people, it is not medically serious. Conventional therapies now available are as follows.

Drug therapy
Drugs to treat heart valve disease are used to relieve symptoms and prevent complications. They do not provide a cure. For example, in mitral valve prolapse, a beta-blocking drug may be prescribed to treat troublesome symptoms such as palpitations and chest pain, even though the condition itself is not serious.

In other forms of valvular disease, digitalis or other drugs to slow the heartbeat and increase its output may be prescribed. A diuretic may be added to prevent retention of salt and water; a salt- restricted diet may be recommended for the same reason. Anticoagulant drugs may be prescribed to prevent blood clots, and anti-arrhythmic drugs may be used to maintain a normal heart rate and rhythm.

Diseased heart valves are highly susceptible to a serious infection called bacterial endocarditis, so it is important to take antibiotics before any dental or surgical procedure that may release bacteria into the bloodstream. Depending on the severity of the disease, a doctor may also recommend avoiding strenuous activities and taking frequent rest periods during the day to minimize the workload on the heart.

Supplements that strengthen the immune system may also be helpful. Immediate and careful treatment of streptococcal throat infections with antibiotics can prevent most cases of rheumatic fever, one of the leading causes of heart valve disease.

(See the Immune Enhancement protocol for more information on strengthening your immune system.)

Surgical Treatment
When the heart valves are seriously damaged and impairing blood flow to the rest of the body or causing heart muscle damage, surgery to replace the defective valve may be recommended. For example, in rare cases of a mitral valve prolapse, the valve may become so weakened that there is excessive backflow of blood or a danger of the valve's rupturing, which can lead to death. In such unusual circumstances, replacement of the defective valve is necessary. A number of durable and highly efficient artificial valves have been developed from animal parts, plastic, and metal.

Novel Surgery to Fix Leaking Aortic
Valves - Pulmonary Valve Transplants

Surgeons at UCSF Stanford go to an unlikely source for a new heart valve in those patients suffering from aortic valvular disease-the other side of a patient's own heart. They use the pulmonary valve from the right side of a patient's heart to replace the defective aortic valve on the left side of the heart.

The pulmonary valve makes an ideal substitute because it is about the same size and shape as the aortic valve, and is able to close tightly, even under high pressure. And the valve is not rejected by the immune system because it is the patient's own tissue.

The aortic valve must form a solid seal to prevent blood from reversing into the heart during contraction. Leakage can occur if the flaps of the valve are congenitally malformed or are corroded by infections or diseases like rheumatoid arthritis. For the patient, a faulty aortic valve causes shortness of breath and fatigue because the heart begins to fail due to the extra work load.

This novel procedure is better than the current alternatives, such as implantation of a mechanical valve or one taken from a pig's heart, which give inferior results over time. Pig valves eventually may be rejected by the body's own immune system, which attacks the animal implants, and blood clots may form on the mechanical valves. A pulmonary human valve transplant, however, can last the lifetime of the patient.

Surgeons can also implant a pulmonary valve taken from the hospital's tissue bank from donated human valves which match the recipient's tissue. If you are facing an aortic valve problem, you may want to ask your physician about this surgical approach.

Integrated and Alternative Prevention

Because of the anatomical nature of valvular disease, prevention may be the best approach to avoid this disorder. For example, there is evidence that the deposition of apolipoprotein A, B, and E (protein variations of the LDL cholesterol) on the aortic valve creates a binding site for calcium. Aortic valve stenosis is often described as a calcification process. Fibrinogen may also contribute to this process by depositing on aortic valves, further adding to deposit buildup by binding with calcium deposits already present on valves. Studies also implicate a chronic inflammatory process that promotes calcium infiltration into the aortic valve.

Preventing or curbing the progression of aortic-valve disease may involve lowering homocysteine, fibrinogen, and apolipoproteins A, B, and E in the blood. Consider regular blood tests to guard against hypercalcemia (too much calcium in the blood) and supplementing with magnesium (500 elemental mg a day) to possibly inhibit excess calcification of the aortic valve. Supplementing with 10 mg a day of vitamin K1 may be especially effective in preventing aortic valve calcification. Long-term anti-inflammatory therapy with nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, or prescription drugs) may be considered under the supervision of a physician. Nutrients that safely inhibit many chronic inflammatory reactions include fish oil, borage oil, curcumin, and ginger. (See the Fibrinogen, Homocysteine, and Atherosclerosis protocols for suggestions on lowering homocysteine, fibrinogen, and apolipoprotein levels.)

Since narrowed and/or leaky heart valves keep blood from being efficiently pumped, and thus place a strain on the heart muscle, we suggest you follow the Congestive Heart Failure and Cardiomyopathy protocol. The nutrients in this protocol will help strengthen the contractility of the heart muscle, but will do nothing to alleviate or correct the underlying anatomical valvular defect.

Summary

Valve-replacement surgical procedures currently are the only effective long-term therapy for valvular insufficiency. Beta-blockers, digitalis, and anticoagulants may be prescribed, depending on the underlying condition, to relieve symptoms and prevent complications, although they do not provide a cure. Preventing or curbing the progression of aortic- valve disease may involve lowering of homocysteine, fibrinogen, and apolipoproteins A, B, and E in the blood. Natural nonsteroidal anti-inflammatory supplements-including aspirin, fish oil, borage oil, curcumin, and ginger-may be considered under physician supervision. Vitamin K1 and magnesium may prevent calcification of the aortic valve. Readers should refer to specific heart disease-related protocols for detailed suggestions regarding nutritional supplementation.

For more information

Refer to the Cardiovascular Disease: Comprehensive Analysis

Contact the National Heart, Lung, & Blood Institute, 301-251-1222.

Product availability

You can order Healthprin (aspirin), fish oil, borage oil, curcumin, vitamin K, and magnesium by calling 1-800-544-4440 or order online.